膝骨性关节炎全膝关节置换术前后患者中医证型变化的研究

目的 :探讨膝骨性关节炎患者在全膝关节置换术前后中医证型的特点及演变规律,为中医药防治膝骨性关节炎提供理论依据。方法:对确诊为膝骨性关节炎患者149例在全膝关节置换术前后进行中医辨证分型和证候分析,比较手术前后证型特点。结果:全膝关节置换术前以气滞血瘀证(60例,40.3%)最为常见,气虚血瘀证27例(18.1%),脾虚湿瘀证24例(16.1%),肾虚血瘀证23例(15.4%),气血亏虚证15例(10.1%);术后以气虚血瘀证(54例,36.2%)最为常见,肾虚血瘀证28例(18.8%),气滞血瘀证20例(13.4%),脾虚湿瘀证24例(16.1%),气血亏虚证23例(15.4%);术前和术后中医证型分布差异具有统计学意义(P0.01)。术前统计,肾虚血瘀证的年龄明显高于其他证型(P0.05)。结论:膝骨性关节炎患者全膝关节置换术前以气滞血瘀证(标实)为主,术后以气虚血瘀证(本虚标实)为主,总体上术后较术前有从实转虚趋势。

Study on Changes of Traditional Chinese Medicine Syndrome in Patients with Knee Osteoarthritis before and after Total Knee Arthroplasty

Objective:To observe the changing laws of traditional Chinese medicine(TCM) syndrome type in patients with knee osteoarthritis(KOA) before and after total knee arthroplasty(TKA) and to provide a theoretical basis for TCM treatment and prevention. Methods:There were 149 patients with KOA during Jan.2015 to Jan. 2016 in Guangdong Provincial TCM Hospital diagnosed as different types of TCM syndrome before and after TKA. Results:Before TKA treatment,qi stagnation and blood stasis was of 60 cases,(40.3%),as the commonest,qi deficiency and blood stasis was of 27 cases(18.1%),spleen deficiency and dampness stagnation was of 24 cases(16.1%),kidney deficiency and blood stasis was of 23 cases(15.4%),deficiency of qi and blood was of 15 cases(10.1%). After TKA treatment,qi deficiency and blood stasis was of 54 cases(36.2%) as the commonest,kidney deficiency and blood stasis was of 28 cases(18.8%),qi stagnation and blood stasis was of 20 cases(13.4%),spleen deficiency and dampness stagnation was of24 cases(16.1%),deficiency of qi and blood was of 23 cases(15.4%). There was a significant difference in TCM syndromes between before and after TKA(P<0.01). The average age of patients of kidney deficiency and blood stasis was the highest(P<0.05). Conclusion:Qi stagnation and blood stasis was the major syndrome of KOA before TKA,while qi deficiency and blood stasis was the major syndrome of KOA after TKA,indicating there was a tendency of from deficiency to excess after TKA in general.